Introduction: Colon polyps are relatively rare in children. They are most commonly found in the left colon and usually present with rectal bleeding. We report an unusual case of a large right sided juvenile polyp presenting with fever and abdominal pain in a child. Case Report: An 11-year-old male with no significant past medical history presented with two days of fever and periumbilical pain. No nausea, vomiting or diarrhea; last bowel movement occurred ten hours prior to admission. The patient was hypotensive to 97/60 and febrile to 101.9 on admission. He had periumbilical tenderness, without rebound or guarding. CT abdomen showed a polypoid hepatic flexure soft tissue density mass. At colonoscopy, a pedunculated 4cm x 3cm polyp with superficial ulceration was found at the hepatic flexure that was removed. Pathology was consistent with a hamartomatous juvenile polyp. Discussion: Isolated juvenile polyps are the most common type of polyps found in the pediatric population (age 3-10), are found in 1-6% of children, and are generally discovered incidentally during colonoscopy for other reasons. They may present with bleeding or rectal prolapse, and are predominantly (75%) left sided. The size of juvenile polyps ranges from 0.5-3cm, and histologically are composed of focal malformations of the mucosal epithelium and lamina propria. Isolated juvenile polyps such as in our case, usually do not have malignant potential in contrast to those found in juvenile polyposis syndrome. This unique presentation with periumbilical pain, mild leukocytosis and tenderness, along with right-sided location initially suggested acute appendicitis. We theorize that the large size of this right sided polyp with obstructive potential likely induced a buildup of cecal pressure. This case demonstrates that a child with periumbilical pain may not just have a stomach virus or even early appendicitis, but we may need to think “outside the box” to make the correct diagnosis. Conclusion: We report a large, right-sided juvenile polyp presenting with acute abdominal pain, mimicking appendicitis.Figure 1: 4x3-cm juvenile polyp.